<div id="oa-deptpayment">			
		<form class="form-horizontal main-form" role="form">
			
			<fieldset>
				<div class="form-group">
					<label for="name" class="col-md-2 col-sm-3 control-label">具体事项</label>
					<div class="col-sm-9 col-md-10">
						<input type="text" class="form-control" id="name" name="name"/>
					</div>
					
				</div>
				<div class="form-group">
					
					<label for="apply_date" class="col-md-2 col-sm-3 control-label">填表日期</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="apply_date" name="apply_date"/>
					</div>
					<label for="bizno" class="col-md-2 col-sm-3 control-label">业务编号</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="bizno" name="bizno"/>
					</div>
				</div>
					
				<div class="form-group">
					<label for="apply_deptname" class="col-md-2 col-sm-3 control-label">申请科室</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="apply_deptname" name="apply_deptname"/>
					</div>
					 <label for="apply_name" class="col-md-2 col-sm-3 control-label">申请人员</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="apply_name" name="apply_name"/>
					</div>
					
				</div>		
				
				
				<div class="form-group">
					 <label for="drug_name" class="col-md-2 col-sm-3 control-label">药品通用名</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="drug_name" name="drug_name"/>
					</div>
					<label for="recommend" class="col-md-2 col-sm-3 control-label">药品商用名</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="recommend" name="recommend"/>
					</div>
				</div>
				
				<div class="form-group">
					 <label for="drug_kind" class="col-md-2 col-sm-3 control-label">药品剂型</label>
					<div class="col-sm-3 col-md-4">
						<select type="text" class="form-control" name="drug_kind" id="drug_kind" >
							<option value="1">口服液体剂</option>
							<option value="2">外用液体剂</option>
							<option value="3">口服散剂</option>
							<option value="4">外用散剂</option>
							<option value="5">软膏剂</option>
							<option value="6">硬膏剂</option>
							<option value="7">吸入剂</option>
							<option value="8">注射剂</option>
							<option value="9">凝胶剂</option>
							<option value="10">颗粒剂</option>
							<option value="11">胶囊剂</option>
							<option value="12">片剂</option>
							<option value="13">粉剂</option>
							<option value="14">散剂</option>
							<option value="15">丸剂</option>
							<option value="16">栓剂</option>
							<option value="17">滴剂</option>
							<option value="18">贴剂</option>
							<option value="19">涂剂</option>
							<option value="20">洗剂</option>
						</select>
					</div>
					<label for="format" class="col-md-2 col-sm-3 control-label">药品规格</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="format" name="format"/>
					</div>
				</div>	
				
				<div class="form-group">
					<label for="base_drug" class="col-md-2 col-sm-3 control-label">基本药物</label>
					<div class="col-sm-3 col-md-4" >
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="base_drug" id="base_drug1" value="1" checked>是
						  </label>
						</div>
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="base_drug" id="base_drug2" value="0">否
						  </label>
						</div>
					</div>
					<label for="apply_drug" class="col-md-2 col-sm-3 control-label">招标品种</label>
					<div class="col-sm-3 col-md-4">
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="apply_drug" id="apply_drug1" value="1" checked>是
						  </label>
						</div>
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="apply_drug" id="apply_drug2" value="0">否
						  </label>
						</div>
					</div>
				</div>
				
				<div class="form-group">
					<label for="longhe_drug" class="col-md-2 col-sm-3 control-label">农合目录</label>
					<div class="col-sm-3 col-md-4" >
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="longhe_drug" id="longhe_drug1" value="1" checked>是
						  </label>
						</div>
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="longhe_drug" id="longhe_drug2" value="0">否
						  </label>
						</div>
					</div>
					<label for="label-medical-insurance" class="col-md-2 col-sm-3 control-label">医保等级</label>
					<div class="col-sm-3 col-md-4" id="label-medical-insurance">
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="medical_insurance" id="medical_insurance1" value="1" checked>甲级
						  </label>
						</div>
						<div class="radio-inline">
						  <label>
						    <input type="radio" name="medical_insurance" id="medical_insurance2" value="0">乙级
						  </label>
						</div>
					</div>
				</div>	
				
				
				
				
				
				<div class="form-group">
					
					<label for="price" class="col-md-2 col-sm-3 control-label">药品价格</label>
					<div class="col-sm-9 col-md-10">
						<input type="text" class="form-control" id="price" name="price"/>
					</div>
				</div>
				
				<div class="form-group">
					 <label for="using" class="col-md-2 col-sm-3 control-label">主要药理</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="using" name="using"/>
					</div>
					<label for="suit" class="col-md-2 col-sm-3 control-label">主要适应症</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="suit" name="suit"/>
					</div>
				</div>
				
				<div class="form-group">
					 <label for="advantage" class="col-md-2 col-sm-3 control-label">同类药品<br/>比较优点</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="advantage" name="advantage"/>
					</div>
					<label for="samelike" class="col-md-2 col-sm-3 control-label">相同相似<br/>品种情况</label>
					<div class="col-sm-3 col-md-4">
						<input type="text" class="form-control" id="samelike" name="samelike"/>
					</div>
				</div>			
						
			
				<div class="form-group">
					<label for="dept_content" class="col-md-2 col-sm-3 control-label">科室意见</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="dept_content" rows="5" name="dept_content"/>
					</div>	
				</div>
				
				<div class="form-group">
					<label for="biz_content" class="col-md-2 col-sm-3 control-label">临床药学意见</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="biz_content" rows="5" name="biz_content"/>
					</div>	
				</div>					
				
				
				<div class="form-group">
					<label for="drug_content" class="col-md-2 col-sm-3 control-label">药剂科意见</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="drug_content" name="drug_content" rows="5"/>
					</div>	
				</div>
				
				<div class="form-group">
					<label for="chargeLeader_content" class="col-md-2 col-sm-3 control-label">业务分管<br/>院长审核</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="chargeLeader_content" name="chargeLeader_content" rows="5"/>
					</div>	
				</div>

				<div class="form-group">
					<label for="pcm_content" class="col-md-2 col-sm-3 control-label">院纪委意见</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="pcm_content" name="pcm_content" rows="5"/>
					</div>	
				</div>
				
				<div class="form-group">
					<label for="drug_control" class="col-md-2 col-sm-3 control-label">药事管理<br/>委员会意见</label>
					<div class="col-sm-9 col-md-10">					
						<textarea  class="form-control" id="drug_control" name="drug_control" rows="5"/>
					</div>	
				</div>

				<div class="form-group">
					<label for="archive" class="col-md-2 col-sm-3 control-label">附件</label>
					<div class="col-sm-9 col-md-10">					
						<div class="fileList" id="archive" name="archive"></div>
					</div>	
				</div>					
												
				<input name="id" id="id" type="hidden" />
				<input name="bizid" id="bizid" type="hidden" />
				<input name="flowInstId" id="flowInstId" type="hidden" />
				<input name="flowTaskId" id="flowTaskId" type="hidden" />
				<input name="created" id="created" type="hidden" />
				<input name="creater" id="creater" type="hidden" />


				<input name="apply_id" id="apply_id" type="hidden" />
				<input id="apply_deptid" name="apply_deptid" type="hidden" />
				<input id="dept_auditid" name="dept_auditid" type="hidden" />
				<input id="dept_audit_deptid" name="dept_audit_deptid" type="hidden" />
				<input id="dept_audit_deptname" name="dept_audit_deptname" type="hidden" />

			</fieldset>
		</form>
</div>
<script>

requirejs(['oaMain','domReady!'],function(flowedit,doc){
	flowedit.initEdit({initElement:null});
})
</script>

